Regulating for quality of care in adult homes

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Abstract

The first component of this study frames the policy discussions leading to the creation of Pennsylvania's Personal Care Home by providing an historical analysis of the housing options offered to the elderly. By the 1970s, increasing need and changes in the social welfare system promoted the creation of boarding homes offering personal, but not skilled nursing care to the elderly. Concerns about the quality of care these residents were receiving led to the enactment of Pennsylvania licensure legislation in 1980. Regulation is discussed as a case study in policy formation following the frameworks of analysis of Chambers (1993) and Blumer, (1971).;The implementation of these regulations to ensure quality of care led to the second, quantitative, component of this study. Using data contained in the annual inspection report prepared for each facility, the author used weighted citations of violations of regulations to assign a Severity Score to 110 randomly selected personal care homes in the Northeast and Central Regions of Pennsylvania. A low Severity Score (few and minor citations) indicated the provision of a higher quality of care. Using the Severity Score as a dependent variable and four characteristics of each home as independent variables, a test of correlation between each characteristic and the Severity Score was made by means of an analysis of variance for the 1986-93 period.;The characteristics tested for correlation with quality of care included: size, (31 residents or more, or less than 31 residents), auspice, (non-profit or for-profit ownership), an urban or rural location, and source of residents' income (exclusively private resources or with some residents drawing on Supplementary Security Income).;Significant correlations were seen for auspice, location, and source of residents' income; no correlation was detected between quality of care and size.;The Severity Score as a index of quality may be useful for persons seeking information about a facility and provides to researchers and social workers an objective measure of quality. Thus the Severity Score may be used as a baseline of information from which to explore issues of quality of care and help frame related policy discussions.